<html>
 <head>
	<title>[var.TITLE]</title>
	<link href="[var.ROOT_CSS_DIR]/main.css" rel="STYLESHEET" type="text/css" charset="iso-8859-1" hreflang="en-us">
	<link href="[var.ROOT_CSS_DIR]/facet/style.css" rel="STYLESHEET" type="text/css" charset="iso-8859-1" hreflang="en-us">	
	<script type="text/javascript" src="[var.ROOT_DIR]js/common.js"></script>
	<script type="text/javascript" src="[var.ROOT_DIR]js/doiMenuDOM.js"></script>
	<script type="text/javascript" src="[var.ROOT_DIR]js/functions.js"></script>
	<script type="text/javascript" src="[var.ROOT_DIR]js/jsmenu.php"></script>
	<script type="text/javascript" src="[var.ROOT_DIR]js/jsmenu.cfg"></script>
	<script type="text/javascript" src="[var.ROOT_DIR]js/jsverify.php?session=[var.SessionVar]"></script>
	<script type="text/javascript" src="[var.ROOT_DIR]js/jsinit.php?session=[var.SessionVar]"></script>
 </head>
 <body bgcolor="FFFFFF" topmargin="0" leftmargin="0" marginheight="0" marginwidth="0">
	<table border="0" cellspacing="0" cellpadding="0" width="100%" align="[var.POSITION]">
		<tr height="100%">
			<td>
			<table border="0" cellspacing="0" cellpadding="0" width="100%" height="100%">
				<tr valign="top">
					<td width="100%">
						<table border="0" cellspacing="0" cellpadding="5" width="100%">
							<tr>
								<td class="FacetHeaderContent" >.:[var.SubHeaderTitle]:.</td>
							</tr>
						</table>
						
						<table border="0" cellspacing="0" cellpadding="5" width="100%">
							<tr>
								<td class="contentTitle">
								Menu
								</td>
							</tr>
							<tr>
								<td class="content2">
								<table cellspacing="2" cellpadding="0">
								 <tr>
								   <td>
								    <input type="button" name="Action" value="<<Back" class="button" onClick="self.location='ais_transaction_custlist.php?FormName=ReceiptForm'">
								   </td>
                                                                                   <td>
								     <input type="button" name="Action" value="Done" class="button" onClick="self.location.replace('[var.SERVER_URL]')">
								   </td>
								 </tr>
								</table>
								</td>
							</tr>
							<tr>
								<td class="content2">
						<!-- FORM SECTION -->
						<table border="0" cellspacing="0" cellpadding="0">
						<form method="post" action="[var.FormAction]" name="[var.HTMLFormName]">

							 <!-- Kode Customer -->
							  <tr>
							    <td class="fieldCaption" align="right">Debtur Code</td>
							    <td class="fieldCaption">:</td>
							    <td class="fieldCaption"><input type="text" name="[bln.CUDEBTUR]" value="[blv.CUDEBTUR;noerr]"  maxlength="255" size="10" onblur='[var.InitFunction]' onkeyup="this.value=this.value.toUpperCase()" class="input" [tbs_check;if [var.FormMode]=Edit;then 'readonly';else '']></td>
							  </tr>
							  <!-- Nama Customer -->
							  <tr>
							    <td class="fieldCaption" align="right">Description</td>
							    <td class="fieldCaption">:</td>							    
							    <td class="fieldCaption"><input type="text" name="[bln.CUNAME]" value="[blv.CUNAME;noerr]" maxlength="255" size="25" class="input"></td>
							  </tr>
								<!-- Alamat -->
							  <tr>
							    <td class="fieldCaption" align="right" valign="top">Address</td>
							    <td class="fieldCaption" valign="top">:</td>							    
							    <td class="fieldCaption">
								<textarea name="[bln.CUADDR]" class="input" rows=3 cols=35 onchange="this.value=this.value.toUpperCase()">[blv.CUADDR;noerr]</textarea>
								</td>
							  </tr>

							  	<!-- Kode Pos -->
							  <tr>
							    <td class="fieldCaption" align="right">Zip Code</td>
							    <td class="fieldCaption">:</td>							    
							    <td class="fieldCaption"><input type="text" name="[bln.CUZIP]" value="[blv.CUZIP;noerr]" maxlength="255" size="25" class="input"></td>
							  </tr>



							<!-- Kode Negara -->
							  <tr>
							    <td class="fieldCaption" align="right">Country</td>
							    <td class="fieldCaption">:</td>							    
							    <td class="fieldCaption">
								<select name="[bln.CNCODE]" class="input">
									<option value="">Select Value</option>
                				<option value="[Countryblk.CNCODE]">[Countryblk.CNDESC;block=option]</option>
								<option>[blv.CNCODE;selected]</option>
									</select>																		    
							    </td>
							  </tr>
							<!-- Telepon -->
  							  <tr>
							    <td class="fieldCaption" align="right">Phone</td>
							    <td class="fieldCaption">:</td>							    
							    <td class="fieldCaption"><input type="text" name="[bln.CUPHONE]" value="[blv.CUPHONE;noerr]" maxlength="255" size="25" class="input"></td>
							  </tr>

							 <!-- Fax -->
  							  <tr>
							    <td class="fieldCaption" align="right">Fax</td>
							    <td class="fieldCaption">:</td>							    
							    <td class="fieldCaption"><input type="text" name="[bln.CUFAX]" value="[blv.CUFAX;noerr]" maxlength="255" size="25" class="input"></td>
							  </tr>
				
							
							<!-- Contact Person -->
  							  <tr>
							    <td class="fieldCaption" align="right">Contact Person</td>
							    <td class="fieldCaption">:</td>							    
							    <td class="fieldCaption"><input type="text" name="[bln.CUCONTACT]" value="[blv.CUCONTACT;noerr]" maxlength="255" size="25" class="input"></td>
							  </tr>

							<!-- E-Mail -->
  							  <tr>
							    <td class="fieldCaption" align="right">E-Mail</td>
							    <td class="fieldCaption">:</td>							    
							    <td class="fieldCaption"><input type="text" name="[bln.CUEMAIL]" value="[blv.CUEMAIL;noerr]" maxlength="255" size="25" class="input"></td>
							  </tr>

							  <!-- NPWP -->
  							  <tr>
							    <td class="fieldCaption" align="right">NPWP</td>
							    <td class="fieldCaption">:</td>							    
							    <td class="fieldCaption"><input type="text" name="[bln.CUNPWP]" value="[blv.CUNPWP;noerr]" maxlength="255" size="25" class="input"></td>
							  </tr>

							  <!-- SKADA -->
  							  <tr>
							    <td class="fieldCaption" align="right">SKADA</td>
							    <td class="fieldCaption">:</td>							    
							    <td class="fieldCaption"><input type="text" name="[bln.CUSKADA]" value="[blv.CUSKADA;noerr]" maxlength="255" size="25" class="input"></td>
							  </tr>


  							<tr>
							    <td class="fieldCaption" align="right">Term Of Payment(TOP)</td>
							    <td class="fieldCaption">:</td>							    
							    <td class="fieldCaption"><input type="text" name="[bln.TOP]" value="[blv.TOP;noerr]" maxlength="255" size="25" class="input"></td>
							  </tr>

                                   
							   <td class="fieldCaption"></td>
							   <td class="fieldCaption"></td>
							   <td align="right" class="fieldCaption">
							   	<table border="0" cellspacing="2" cellpadding="0">
							   		<tr>
										<td>[tbs_check;block=td;if [var.FormMode]=Add][tbs_check;block=td;if [var.USER_CANINSERT]=1]
							   			<input name="Action" type="submit" value="Add" class="button" OnClick="return [tbs_check;if [var.Verification]=Enable;then 'VerifyForm(this.form)';else 'true']">
							   			</td>
							   			<td>[tbs_check;block=td;if [var.FormMode]=Edit][tbs_check;block=td;if [var.USER_CANUPDATE]=1]
							   			<input name="Action" type="submit" value="Update" class="button" onclick="return [tbs_check;if [var.Verification]=Enable;then 'VerifyForm(this.form)';else 'true']">
							   			</td>
							   			<td>[tbs_check;block=td;if [var.FormMode]=Edit][tbs_check;block=td;if [var.USER_CANDELETE]=1]
							   			<input name="Action" type="submit" value="Delete" class="button">							   			
							   			</td>
							   			<td>
							   			<input name="Action" type="button" value="Cancel" class="button" onClick="self.location='ais_transaction_custlist.php?FormName=ReceiptForm'">
							   			</td>
							   		</tr>
							   	</table>
							    </td>
							  </tr>
						 </form>
						 </table>
						 <!-- FORM SECTION -->
								</td>
							</tr>
						</table>						
					</td>
				</tr>
			</table>
			</td>
		</tr>
		<tr>
			<td>
			<br>
			<table border="0" cellspacing="0" cellpadding="0" width="100%">
				<tr>
					<td class="footer1"><img src="images/spacer.gif" height="1" width="1"></td>
				</tr>
				<!--tr>
					<td class="footer2">Prototype Test - Web Application</td>
				</tr-->
			</table>
			</td>
		</tr>		
 	</table>
 </body>
</html>
